A 50-year-old man is diagnosed with chronic pancreatitis and intractable pain not responding to medical management. Imaging shows a dilated main pancreatic duct of 8 mm with multiple calculi. Which procedure is MOST appropriate?
- A Whipple's procedure (pancreaticoduodenectomy)
- B Thoracoscopic splanchnicectomy for pain relief
- C Lateral pancreaticojejunostomy (Puestow-Gillesby procedure) ✓
- D Total pancreatectomy with islet autotransplantation
Correct answer: C. Lateral pancreaticojejunostomy (Puestow-Gillesby procedure)
Explanation
Lateral pancreaticojejunostomy (modified Puestow or Partington-Rochelle procedure) is the procedure of choice for painful chronic pancreatitis with a dilated main pancreatic duct (>6-7 mm) — it decompresses the ductal system longitudinally by anastomosing the split duct to a Roux-en-Y jejunal loop. It preserves pancreatic parenchyma and has good pain relief in 70-80% of carefully selected patients. Whipple's is more appropriate when the head is predominantly involved with a mass. Total pancreatectomy is a last resort.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.